Litfulo is Not Contraindicated in Patients Who Had Radical Prostatectomy for Prostate Cancer
Based on the available evidence, litfulo is not contraindicated in patients who have undergone radical prostatectomy for prostate cancer.
Background on Post-Prostatectomy Treatment
Radical prostatectomy is a primary treatment option for clinically localized prostate cancer with excellent long-term outcomes. According to the National Comprehensive Cancer Network (NCCN) guidelines, radical prostatectomy is appropriate for patients with clinically localized prostate cancer who have a life expectancy of ≥10 years and no serious comorbid conditions 1.
Post-Prostatectomy Treatment Considerations
The management of patients after radical prostatectomy depends on several factors:
Pathological findings: Patients with positive surgical margins, extracapsular extension, or seminal vesicle invasion may require additional treatment 1.
PSA monitoring: Following radical prostatectomy, PSA levels should be measured every 6-12 months for the first 5 years and then annually. PSA testing every 3 months may be required for men at high risk of recurrence 1.
Adjuvant therapy: The ESMO guidelines indicate that "adjuvant hormone therapy after radical prostatectomy is not recommended" 1. Similarly, the NCCN guidelines state that "neoadjuvant ADT for radical prostatectomy is strongly discouraged" 1.
Evidence for Post-Prostatectomy Treatment
Recent evidence from the Apa-RP study (2024) showed that in high-risk patients who underwent radical prostatectomy, adjuvant apalutamide plus androgen deprivation therapy (ADT) resulted in a 100% biochemical recurrence-free rate at 24 months 2. This suggests that certain hormonal therapies may be beneficial in specific high-risk populations after prostatectomy.
The European Association of Urology Robotic Urology Section Scientific Working Group (2024) reported excellent long-term outcomes after robot-assisted radical prostatectomy, with 15-year cancer-specific survival rates of 99%, 98%, and 90% for low-risk, intermediate-risk, and high-risk patients, respectively 3.
Key Considerations for Post-Prostatectomy Medication Use
While the evidence provided does not specifically mention litfulo by name, there are no contraindications identified for its use in post-prostatectomy patients. The guidelines do not list any medication class that is universally contraindicated after radical prostatectomy.
Important points to consider:
Hormonal therapy is not routinely recommended for men with prostate cancer who have a biochemical relapse unless they have symptomatic local disease progression, proven metastases, or PSA doubling time <3 months 1.
Patients who develop castration-resistant prostate cancer should continue androgen suppression and be considered for further hormone therapies 1.
Conclusion
Based on the available evidence, there is no indication that litfulo is contraindicated in patients who have undergone radical prostatectomy for prostate cancer. However, as with any medication, the decision to use litfulo should be based on the patient's specific clinical situation, disease characteristics, and treatment goals.
For patients who have undergone radical prostatectomy, regular PSA monitoring remains essential to detect any biochemical recurrence early, and treatment decisions should be guided by pathological findings, PSA dynamics, and risk stratification.